{include file="header" /}


		<div class="box">
		  <div class="box_top pro_text_top">
		  	
		  </div>
		  <div class="pro_text_form">
		  	<form class="pro_form" action="{:url('index/scan/detail')}" method="post">
		  		<span class="pro_text_box">
		  			<i>1</i>
		  			<input type="text" value="" placeholder="姓名"/>
		  		</span>
		  		<span class="pro_text_box">
		  			<i>2</i>
		  			<input type="text" value="" placeholder="身份证"/>
		  		</span>
		  		<span class="pro_text_box">
		  			<i>3</i>
		  			<input type="text" value="" placeholder="电话号码"/>
		  		</span>
		  		<span class="pro_text_box no_border">
		  			<input type="text" value="" placeholder="验证码"/>
		  			<em class="no_border f_right">发送验证码</em>
		  		</span>
		  		<input class="pro_form_btn no_border" type="submit" value="提交审核"/>
		  	</form>
		  </div>
		</div>
	</body>
</html>
